Abstract
BackgroundExamination of consultation data in a variety of primary care settings in Tanzania shows that, while psychoses are routinely diagnosed and treated at primary care level, depression is rarely recorded as a reason for consultation. Since, epidemiological studies elswhere show that depression is a much more common disorder than psychosis, a series of studies were undertaken to elucidate this apparent paradox in Tanzania and inform mental health policy; firstly, a household prevalence study to ascertain the prevalence of common mental disorders at community level in Tanzania; secondly, a study to ascertain the prevalence of common mental disorders in primary care attenders; and thirdly, a study to ascertain the current status of the knowledge, attitude and practice pertaining to depression among primary health care workers. This paper reports the findings of the latter study.MethodsAll the primary health care workers (N = 14) in four primary health care centres in Tanzania were asked to complete the Depression Attitude Questionnaire, which assesses the health worker's knowledge and attitude towards the causes, consequences and treatment of depression.ResultsThe majority of respondents felt that rates of depression had increased in recent years, believed that life events were important in the aetiology of depression, and generally held positive views about pharmacological and psychological treatments of depression, prognosis and their own involvement in the treatment of depressed patients.However, the majority of respondents felt that becoming depressed is a way that people with poor stamina deal with life difficulties.ConclusionThe findings suggest a need to strengthen the training of primary health care workers in Tanzania about the detection of depression, pharmacological and psychological treatments, and psychosocial interventions.
Highlights
Examination of consultation data in a variety of primary care settings in Tanzania shows that, while psychoses are routinely diagnosed and treated at primary care level, depression is rarely recorded as a reason for consultation
The findings suggest a need to strengthen the training of primary health care workers in Tanzania about the detection of depression, pharmacological and psychological treatments, and psychosocial interventions
The health workers were ten nurses with a three year or four year general nurse training, and four assistant medical officers with a three year training. They had received a short mental health module in their basic training, received according to the Tanzanian national curricula, but had not at that time received any mental health continuing professional development (CPD) since their basic training. This situation was similar to that pertaining across East Africa and sub Saharan Africa, there are systematic efforts to provide mental health CPD across several regions of Tanzania, and some other countries including a national programme in Kenya, and a pilot programme in Malawi
Summary
Examination of consultation data in a variety of primary care settings in Tanzania shows that, while psychoses are routinely diagnosed and treated at primary care level, depression is rarely recorded as a reason for consultation. Epidemiological studies elswhere show that depression is a much more common disorder than psychosis, a series of studies were undertaken to elucidate this apparent paradox in Tanzania and inform mental health policy; firstly, a household prevalence study to ascertain the prevalence of common mental disorders at community level in Tanzania; secondly, a study to ascertain the prevalence of common mental disorders in primary care attenders; and thirdly, a study to ascertain the current status of the knowledge, attitude and practice pertaining to depression among primary health care workers. Human resources devoted to health systems in sub-Saharan Africa are scarce. In order to bring health care to the population, strategic primary care structures have evolved, there is widespread concern about their performance and capacity to deliver in resource poor settings. 1000 mental health nurses have been trained, but only 460 are currently deployed in the mental health services
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